Healthcare Provider Details

I. General information

NPI: 1689738858
Provider Name (Legal Business Name): PATRICIA L. ROONEY, D.O.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 SPRING ARBOR RD STE 300
JACKSON MI
49203-3652
US

IV. Provider business mailing address

2575 SPRING ARBOR RD STE 300
JACKSON MI
49203-3652
US

V. Phone/Fax

Practice location:
  • Phone: 517-783-6290
  • Fax: 517-784-3753
Mailing address:
  • Phone: 517-783-6290
  • Fax: 517-784-3753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number5101013687
License Number StateMI

VIII. Authorized Official

Name: PATRICIA L. ROONEY
Title or Position: OWNER
Credential: D.O.
Phone: 517-783-6290